Healthy Start Stories |
Josephine Wagenaar

Pressure on healthcare: ‘How can we make care for babies and children future-proof?”

Healthcare in the Netherlands is under pressure. The work is heavy and there is a chronic shortage of personnel. If we don’t do anything, healthcare will get further and further into trouble. This also applies to the care of babies and children. What can we do to keep the quality of care for the little ones as high as possible? And what do care providers need to continue to perform their work in the children’s ward properly? Josephine Wagenaar, pediatrician in training and PhD student at Healthy Start, tells us about this.

“There have been signs for years that the pressure on healthcare in the Netherlands is far too high. This certainly applies to acute care, general practitioner care and care for the elderly. As a pediatrician in training, I experience at first hand how heavy the pressure is on the care of babies and children. As in the ‘neonatology intensive care’ department of the Sophia Children’s Hospital. This is a special ward for newborn babies who need constant intensive care. For example, because they were born much too early or because they are seriously ill. The work in this department is intense. The babies lying here need a lot of care, while the department is often understaffed due to a shortage of staff. As a result, not all beds can be made available. As a result, some babies have to be transferred to another hospital. This is very stressful for the parents and for the child and it requires a lot of organizing work from the nurses. This is just one example of the heavy workload on healthcare workers. I want to know how we can relieve the pressure on healthcare providers, so that care for newborn babies and children becomes future-proof.”

As a pediatrician in training, I experience at first hand how heavy the pressure the pressure is on the care of babies and children

From Technical Policy and Management to Medicine

“Years ago, before I decided to study Medicine, I started a bachelor in Technical Policy and Management at TU Delft. It was an exciting study. I learned to look at complex social problems from different perspectives. It was mathematical and technological, but I also took subjects such as Economics, Management and Law. Nevertheless, after obtaining my bachelor’s degree, I decided not to continue with this study. In the end I didn’t see myself working in an office. I much preferred to be able to mean something concrete for people. That’s why I decided to make the switch to Medicine.

During this training my enthusiasm for pediatrics arose. What appealed to me so much was the fact that as a pediatrician you look beyond the clinical picture. For example, I recently had a girl at my consultation who told me that her asthma had been bothering her a lot more lately. When I inquired further, it turned out that she regularly forgot her puffer since her parents divorced. The solution was simple: I gave her two inhalers. Now she always has one with her father and one with her mother.

Once I started education as a pediatrician, I was increasingly confronted with the heavy pressure on healthcare. This certainly applied to the neonatology intensive care unit. Nurses in this department are constantly exposed to all kinds of beeps and alarm signals. Only when they have a break they can escape from all those stimuli. In addition, there is the constant pressure to ensure that every baby receives the right care in the right place. The situation is now dire. If we want to future-proof the care for newborn babies, we really need to think about other solutions.”

I am convinced that care for patients improves when healthcare providers go to work with pleasure and energy

Research into job satisfaction and predictability of care

“Within Healthy Start I am concerned with the question of how we can ensure that all children receive the right care in the right place without overloading the care system. To this end, I am conducting two research projects. In one of the projects I focus on nurses from the intensive care units of the Sophia Children’s Hospital. I want to know how they experience the workload, why there is so much absenteeism among the staff and what it takes to increase their job satisfaction. I am convinced that care for patients improves when healthcare providers go to work with pleasure and energy. Research into the pressure on healthcare personnel is not new, but unfortunately nurses have traditionally been little involved in scientific research. In this research project, we are working together with nurses.

Within the other project I am researching the predictability of care. If we are better able to predict where and when the pressure on healthcare will increase, we can also try to prevent this. To this end, I will be developing a simulation model together with a TU Delft research group. I like that my background in technical management comes in handy here. By incorporating data from the current situation in healthcare into the model, we can predict what will happen if one link changes. For example, what happens if an antibiotic treatment is not given in the university hospital, but at home under the supervision of home care? Will this lead to less pressure on healthcare and healthcare providers? Instead of having to experience this in practice, we can use the simulation models to estimate whether this change makes sense, and if not, what possible alternatives are.”

Low-threshold collaborations

“When Vincent Jaddoe (Erasmus MC Sophia Children’s Hospital) approached me about this PhD research, all options were still open. That is very different from most PhD programs. As a PhD candidate within Healthy Start, I enjoy a lot of freedom to choose what I want to focus my research on. The focus is less explicitly on scientific output, but much more on its social significance. We make every effort to ensure that the results of my research can really be used in practice.

But what perhaps appeals to me most is the low threshold with which I can collaborate with other professionals within Healthy Start. I not only work with doctors and nurses from Erasmus MC, but also with scientists from Delft University of Technology and Erasmus University. They participate in the development of the simulation models and help design special questionnaires to measure the workload among nurses.”

If we really want to bring about change in practice, it is important to keep focus

Dare to say ‘no’

“Of course there are also challenges when you do research in such a large consortium. Especially if you work with people from other disciplines who are also located at other locations. In addition, as scientists and healthcare providers, we have to exchange a lot of data with each other in the context of research, but that is not always possible due to privacy legislation.

Within Healthy Start we work on complex and large-scale social problems. That also means that you have to learn to set limits and dare to say ‘no’. It’s not always easy, but I’m getting better and better along the way. If we want to do too much at once, we run the risk that nothing will happen at all. If we really want to bring about change in practice, it is important to keep focus.”

Josephine Wagenaar’s Healthy Start perspective
“I think it’s special to be the first PhD candidate to be involved in Healthy Start. Here I really get the space to improve what I encounter as a pediatrician in training. Namely the heavy pressure on the care of babies and children, as well as their parents. In addition, Healthy Start offers me the opportunity to make connections between different disciplines and to bring people into contact with each other. In that sense, I can optimally combine the Technical Policy and Management and Medicine programs here. To move forward, it is important that we continue to seek out others. A lot of research is being done into the pressure on healthcare and there are a lot of people who want to solve this problem. So let’s not reinvent the wheel every time, but let’s do our best to bundle existing needs and initiatives. I am convinced that this will take us further.”

Josephine Wagenaar is a pediatrician in training at the Erasmus MC Sophia Children’s Hospital and the first Convergence Healthy Start PhD candidate. She is a core team member of the ambition ‘pediatric hospital of the future’ and member of the Healthy Start Young Board.

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